MEDICARE: HEATHER RENYE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	228550	NC

General Provider Information

NPI Number	:	1710659214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER RENYE

Provider Business Mailing Address
First Line	:	109 ST LAWRENCE DR
Second Line	:
City	:	ROCKY POINT
State	:	NC
Zip	:	28457-1324
Country	:	US
Telephone Number	:	401-481-6238
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 PINE GROVE DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5136
Country	:	US
Telephone Number	:	910-262-1722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2021
Last Update Date	:	10/02/2021

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Directions to “ HEATHER RENYE ” Practice Location

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